Mohapatra Satarupa, Mourad Yasser R Abou, M Cherniawsky Hannah, S Chung Shanee, L Forrest Donna, Kaila Gagan, Kuchenbauer Florian, Lacaria Katie, MacLean Joanna, H Nantel Stephen, Narayanan Sujaatha, J Nevill Thomas, A Rodrigo Judith, Rouhi Arefeh, Roy Claudie, Sanford David, W Song Kevin, J Stubbins Ryan, L Toze Cynthia, K White Jennifer, P Lad Deepesh
Leukemia/Bone Marrow Transplant Program of British Columbia, Vancouver, Canada.
Division of Hematology, Department of Medicine, University of British Columbia, Vancouver, Canada.
Blood Cell Ther. 2025 Jul 18;8(3):228-233. doi: 10.31547/bct-2025-001. eCollection 2025 Aug 25.
The impact of race on outcomes of allogeneic hematopoietic cell transplants (HCT) has long been a field of research. The Center for International Blood and Marrow Transplant Research (CIBMTR) studies have shown worse survival for Black and Hispanic patients within the first year after HCT, but rates evened out for one-year survivors. From our personal experience, we hypothesize that the outcomes of South Asians (age ≥ 45 years) receiving myeloablative conditioning (MAC) are also worse compared to other races.
This is a retrospective single-centre study. All patients (age ≥ 45 years) undergoing MAC-HCT for hematological malignancies from 2011-2022 were included. The primary outcome was overall survival (OS). Secondary outcomes were non-relapse mortality (NRM), incidence of grade 2-4 acute graft versus host disease (GVHD), moderate-severe chronic GVHD and relapse incidence (RI). The survival analysis was performed using Kaplan-Meier analysis and log-rank test. The GVHD, NRM and RI rates were calculated using the cumulative incidence (CI) of competing events and the Gray test. EZR was used for statistical analysis.
Of the 483 patients included, there were 28 (5.8%) South Asians (SA), 73 (15.1%), other Asians (East Asians (EA)/Southeast Asians (SEA), and 382 (79.1%) Whites (W). Asians were less likely to get matched unrelated donor-HCT than Whites (SA 21%, EA/SEA 30%, W 45%, =0.009). The three groups were comparable regarding the recipient and donor sex and performance status. The proportion of SA with HCT-CI ≥ 3 was significantly higher (SA 50%, EA/SEA 37%, W 31%, =0.03). SA patients were more likely to be obese (body mass index ≥ 30 kg/m) (SA 29%, EA/SEA 5%, W 19%, =0.005). There were fewer cytomegalovirus (CMV) serological mismatches among the Asians (SA 25%, EA/SEA 26%, W 43%, =0.009). There was no difference in the conditioning type and CD34 cell dose. However, fewer Asians received Antithymocyte globulin/post-transplant cyclophosphamide as GVHD prophylaxis (SA 39%, EA/SEA 42%, W 45%, =0.0009). The median OS was significantly shorter in SA (SA 19, EA/SEA 103, W 65 months, =0.04). The 2-year NRM was significantly higher in SA (SA 35.7%, EA/SEA 13.7%, W 16%, =0.03). The CI of grade 2-4 acute and moderate-severe chronic GVHD was not significantly different (=0.7 & 0.6). The 2-year RI was also not significantly different (SA 28.5%, EA/SEA 24.7%, W 28%, =0.8).
Our study confirms that South Asians aged ≥ 45 years have worse survival after MAC-HCT. Supportive care is unable to overcome the differences in the outcomes.
种族对异基因造血细胞移植（HCT）结果的影响长期以来一直是一个研究领域。国际血液和骨髓移植研究中心（CIBMTR）的研究表明，黑人和西班牙裔患者在HCT后的第一年内生存率较低，但一年幸存者的生存率趋于平衡。根据我们的个人经验，我们推测接受清髓性预处理（MAC）的南亚人（年龄≥45岁）与其他种族相比，其移植结果也较差。
这是一项回顾性单中心研究。纳入了2011年至2022年期间所有因血液系统恶性肿瘤接受MAC-HCT的患者（年龄≥45岁）。主要结局是总生存期（OS）。次要结局包括非复发死亡率（NRM）、2-4级急性移植物抗宿主病（GVHD）的发生率、中重度慢性GVHD以及复发率（RI）。生存分析采用Kaplan-Meier分析和对数秩检验。GVHD、NRM和RI率使用竞争事件的累积发生率（CI）和Gray检验进行计算。使用EZR进行统计分析。
在纳入的483例患者中，有28例（5.8%）南亚人（SA），73例（15.1%）其他亚洲人（东亚人（EA）/东南亚人（SEA）），382例（79.1%）白人（W）。亚洲人获得匹配无关供体-HCT的可能性低于白人（SA为21%，EA/SEA为30%，W为45%，P = 0.009）。三组在受者和供者性别以及体能状态方面具有可比性。HCT-CI≥3的SA比例显著更高（SA为50%，EA/SEA为37%，W为31%，P = 0.03）。SA患者更易肥胖（体重指数≥30 kg/m²）（SA为29%，EA/SEA为5%，W为19%，P = 0.005）。亚洲人中巨细胞病毒（CMV）血清学不匹配的情况较少（SA为25%，EA/SEA为26%，W为43%，P = 0.009）。预处理类型和CD34细胞剂量无差异。然而，接受抗胸腺细胞球蛋白/移植后环磷酰胺作为GVHD预防的亚洲人较少（SA为39%，EA/SEA为42%，W为45%，P = 0.0009）。SA的中位OS显著较短（SA为19个月，EA/SEA为103个月，W为65个月，P = 0.04）。SA的2年NRM显著更高（SA为35.7%，EA/SEA为13.7%，W为16%，P = 0.03）。2-4级急性和中重度慢性GVHD的CI无显著差异（P = 0.7和0.6）。2年RI也无显著差异（SA为28.5%，EA/SEA为24.7%，W为28%，P = 0.8）。
我们的研究证实，年龄≥45岁的南亚人在MAC-HCT后的生存率较差。支持性治疗无法克服移植结果的差异。
